Page 10 - 2024 HCTec Benefits Guide

Vision Plan

The vision plan provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or contact
lenses. You can choose any provider; however, you always save money if you see in-network providers in the BlueCross make tax-free contributions to a savings account to pay for current and future medical expenses for you and your
BlueShield of Tennessee network. dependents.

BCBST Vision
Plan Provision In-Network Out-of-Network

Exam $20 copay Exam
$120 allowance
Frames 20% discount off Frames
balance over allowance
Lenses Lenses
 Single vision lenses $20 copay  Single vision lenses
 Bifocal lenses $20 copay  Bifocal lenses
 Trifocal lenses $20 copay Trifocal lenses

Contact Lenses Contact Lenses
 Elective $120 Allowance  Elective
 Medically necessary Covered in full Medically necessary

Frequency Frequency
 Exam 12 Months  Exam
 Frames 24 Months  Frames
 Lenses or Contact 12 Months Lenses or Contact
lenses lenses

Find a Provider
Search for in-network providers at bcbst.com/findadoctor. You will have lower
cost if you stay in-network.
.
• Select: Vision

• Or call: 1-800-565-9140 8am to 6pm EST Monday through Friday

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